Folic acid supplementation in NTD

Abundant scientific evidence has shown a link between maternal folic acid deficiency during early pregnancy and the development of neural tube defects in the fetus. The American Academy of Pediatrics has recommended "all women of childbearing age who are capable of becoming pregnant should consume 400 micrograms of folic acid daily". For women who have had a child with a neural tube defect and women who themselves have a neural tube defect, the American Academy of Pediatrics recommends "4000 micrograms of folic acid per day starting 1 month before the time they plan to become pregnant and throughout the first 3 months of pregnancy, unless contraindicated". Also see Neural Tube Defects - AAP Policy Statement on Folic Acid Supplementation
Although folate acid supplementation has decreased the incidence of neural tube defects in the United States to somewhere between 25 and 45%, [Jägerstad: 2012] there are clearly other factors that are also important. In one area of the country, these included obesity, high serum homocysteine levels, low serum B12 levels, stress, and exposure to fumonisms, which are fungi produced toxins in corn grain. [Suarez: 2012]


Practice Guidelines

The following provides guidance on folic acid supplementation.

Cheschier N.
ACOG practice bulletin. Neural tube defects. Number 44, July 2003. (Replaces committee opinion number 252, March 2001).
Int J Gynaecol Obstet. 2003;83(1):123-33. PubMed abstract

Authors & Reviewers

Last update/revision: February 2009
Current Authors and Reviewers:
Authors: Lynne M. Kerr, MD, PhD
Margaret Braae, RD

Page Bibliography

Jägerstad M.
Folic acid fortification prevents neural tube defects and may also reduce cancer risks.
Acta Paediatr. 2012;101(10):1007-12. PubMed abstract

Suarez L, Felkner M, Brender JD, Canfield M, Zhu H, Hendricks KA.
Neural tube defects on the Texas-Mexico border: what we've learned in the 20 years since the Brownsville cluster.
Birth Defects Res A Clin Mol Teratol. 2012;94(11):882-92. PubMed abstract